Research has well established that in healthy individuals, lumbopelvic stabilizing muscles contract automatically in anticipation of an arm or leg movement (Rydeard, Leger, Smith). This action provides a protective stabilizing force to prevent excess wear and tear on vulnerable components of the low back. Studies have also shown that people who suffer low back pain are missing this automatic, perfectly timed pre-emptive stabilizing contraction. It is possible to re-train your core stabilizers to have the strength and timing to provide the support needed to prevent low back pain. When done correctly, core stabilization exercises such as the march can help. Next month we will cover a more advanced version of this .
First, a lesson in lumbo-pelvic anatomy: deep stabilizing muscles work best when joints are in a neutral position. The pelvis and lumbar spine are in neutral when the bony points at the front of the hips (Anterior Superior Iliac Spine, or ASIS) and the pubic bone are in a plane that is horizontal if lying flat, or vertical if upright. To assess the position of your pelvis, place the heel of your hand on your ASIS bones and your fingertips on your pubic bones.
Now that you have found neutral, let’s have you identify four of the muscle groups that provide stability for the pelvis and low back. Remember, if you are using the deep stabilizing muscles correctly they are only working at 25% of their maximum contraction, so you will feel only a gentle contraction.
Pelvic Floor: The Pelvic Floor Muscles provide support for the bottom of the pelvis-they attach from the pubic bones to the tailbone and from one sit bone to the other. Contract them by gently lifting in and up as if you were trying to hold back gas or prevent urine flow (Kendall 189).
Transversus Abdominus: This broad, flat muscle crosses transversely across your body at your bikini line. To engage, gently pull the belly inward (Kendall 193).
Lumbar Multifidi: These are small muscles that attach one vertebrae to the next and provide segmental stability to the entire spine. To find or engage these muscles, simply think of stiffening the spine in its neutral position (a slight arch to the low back) which will engage the multifidi (Kendall 228).
Obliques: These are one layer above your transversus abdominus. To engage these muscles think of connecting your lower ribs to the front of your pelvis without flattening your low back. If you are unsure how to contract the obliques, put your hands on your belly and feel them automatically contract as you cough or laugh. The obliques help to pull down on the ribs to expel air forcefully, and are the reason we notice our belly hurting after a good long laughing fit (Kendall 191).
To put it all together engage the stabilizing muscles and low back and pelvis by gently pulling pelvic floor and transversus abdominus up and in at your bikini line. Then engage your obliques and multifidi and connect the ribs to the hips to brace at your lower spine. Be sure to contract your core stabilizing muscles a split second before moving your leg to strengthen the neural pathway that creates stability in anticipation of turbulence that may otherwise jar the pelvis and low back.
Inhale: prepare in neutral
Exhale: Contract core stabilizers (as above), then lift one foot just off the floor, maintaining neutral
Inhale: Return foot to floor
Exhale: Contract core stabilizers (as above) to support neutral and lift the other foot just off the floor
– Allowing the pelvis and low back to shift from neutral-if you feel any movement of your pelvis, ask yourself if you have sufficiently activated all of the above lumbopelvic stabilizing muscles.
– Flattening the low back to the ground.
– “Gripping” by using large muscles like the gluteals and lumbar paraspinals.
– Lifting the foot/knee so high that the pelvis and low back shift out of neutral-only move the leg so far that you can truly maintain stability, re-assess your position with your hands if necessary!
|Kendall, Florence Peterson, Elizabeth Kendall. McCreary, and Henry Otis Kendall. Muscles, Testing and Function. 3rd ed. Baltimore: Williams & Wilkins, 1983. Print.|
Merrithew Corp. Comprehensive Matwork. Toronto: Stott Pilates, 2001. Print.
Rydeard, PT, MSc, Rochenda, Andrew Leger, PT, PhD, and Drew Smith, PhD. “Pilates-Based Therapeutic Exercise: Effect on Subjects With Nonspecific Chronic Low Back Pain and Functional Disability: A Randomized Controlled Trial.” Journal of Orthopaedic & Sports Physical Therapy 56.7 (2006): 473. Print.